Managing Neuraxial Blockade in a Complex Case: Severe Scoliosis With Congenital Dwarfism - A Tertiary Center Experience

Background: Scoliosis is a complex deformity of vertebral spines resulting in lateral curvature, rotation of the vertebrae and deformity of the rib cage resulting in restrictive lung pattern. Anaesthetic management during surgical interventions in scoliosis patients poses notable challenges, primarily in airway and respiratory management. This case study delves into the intricate management of neuraxial blockade in a patient presenting with a challenging medical prole characterized by severe scoliosis compounded by congenital dwarsm. The study outlines the strategies employed, the procedural considerations, and the outcomes observed in a tertiary care setting. Through this case, the nuances of navigating neuraxial blockade in complex anatomical variations are elucidated, offering valuable insights for clinical practice and further research.(1) A 34-year-old female with severe idiopathic scoliosis, Co Case Study: bb's angle >80 degrees, and congenital dwarsm presented for hernioplasty due to umbilical hernia. Using a midline approach at the L1-L2 space, spinal anesthesia was administered with a 23 G Quincke needle angled towards the convex side of the spinal curve. A combination of Levobupivacaine 0.5% hyperbaric 2.3 ml and Buprenorphine 60 µg was injected after ensuring adequate cerebrospinal uid ow, resulting in a dense block at level T6. The patient's intraoperative occurrences, hemodynamic stability was all carefully observed and noted. The procedure went smoothly without any complications, exhibi Result: ting notable hemodynamic stability. This case report underscores that despite the challenges linked to scoliosis, Conclusion: most patients, irrespective of prior corrective surgeries, can reliably undergo successful neuraxial anaesthesia. It's prudent to minimize the use of general anaesthesia in cases of severe scoliosis due to potential difculties with airway management and the presence of a restrictive lung pattern.